# KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC
- **Other names:** Shady Grove Medical Center Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871651349
- **Legal business name:** KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES,INC
- **Authorized official:** COLLEEN SWINTON (CREDENTIALING DIRECTOR)
- **Authorized official phone:** (301) 257-2797

## Contact information

- **Practice address:** 1396 PICCARD DRIVE, ROCKVILLE, MD 20850-4302
- **Practice address phone:** (301) 548-5755
- **Practice address fax:** (301) 548-5701
- **Mailing address:** 4000 GARDEN CITY DR, HYATTSVILLE, MD 20785-2418
- **Mailing address phone:** (301) 816-2424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/05/2006
- **Last updated:** 10/10/2025